EP.TU.701Colon Capsule Endoscopy versus Computed Tomographic Colonography for identifying Colorectal Cancer and Polyps: a systemic review and meta-analysis

Abstract Aim Early diagnosis and treatment of Colorectal Cancer can improve outcomes. Polypectomy with colonoscopy has failure and incompletion rates with risk of aerosol-generation. Computed Tomographic Colonography, second investigation, is limited by radiation exposure and aerosol generation. Colon Capsule endoscopy is a novel technique without gas insufflation, therefore avoiding the discomfort and aerosol-generation. Our aim is to compare the yield of the CCE with CTC in CRC and polyps in patients with positive stool tests or diagnosed colorectal lesions. Methods Review followed PRISMA standards. Electronic database (EMBASE, MEDLINE, PubMed, CINAHL) searched for RCTs and Observational studies. MedCalc Statistical Software used for the synthesis of results. Primary (Per-Lesion and Per-Patient sensitivity analysis) and secondary (Other lesion and completion rate sensitivity analysis) outcomes measured using a random-effect model. Results We found one RCT and three observational studies. Per-Lesion Sensitivity Analysis of CCE versus CTC showed overall effect of 1.903 (0.990- 1.937), p-value-0.057. Per-Patient Sensitivity Analysis of showed overall effect of 1.928 (0.995-1.892), p-value-0.054. Other lesions Sensitivity Analysis showed overall effect of 0.810 (0.121-161.995), p-value-0.418. Completion Rate Sensitivity Analysis showed overall effect of -0.419 (0.526-1.516), p-value-0.676. Conclusion CCE had a better detection rate for colorectal cancer and polyp than the CTC, but this was not statistically significant. Therefore, this study failed to prove CCE's superiority over CTC. A careful decision can be made in current COVID-19 pandemic since its advantage of zero aerosolisation. Researchers should focus on innovation in techniques and simultaneous high-quality studies to evaluate them.

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Response: Re: Cost-Effectiveness of Computed Tomographic Colonography Screening for Colorectal Cancer in the Medicare Population

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djq383 ◽

2010 ◽

Vol 102 (21) ◽

pp. 1676-1677

Author(s):

A. B. Knudsen ◽

I. Lansdorp-Vogelaar ◽

C. M. Rutter ◽

J. E. Savarino ◽

M. Van Ballegooijen ◽

...

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Computed Tomographic Colonography ◽

Computed Tomographic ◽

Medicare Population

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Comparing the Cost-Effectiveness of Innovative Colorectal Cancer Screening Tests

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa103 ◽

2020 ◽

Cited By ~ 1

Author(s):

Elisabeth F P Peterse ◽

Reinier G S Meester ◽

Lucie de Jonge ◽

Amir-Houshang Omidvari ◽

Fernando Alarid-Escudero ◽

...

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Incremental Cost ◽

Screening Tests ◽

Computed Tomographic Colonography ◽

Computed Tomographic ◽

Colonoscopy Screening ◽

Life Years ◽

Stool Dna ◽

The Cost

Abstract Background Colorectal cancer (CRC) screening with colonoscopy and the fecal immunochemical test (FIT) is underused. Innovative tests could increase screening acceptance. This study determined which of the available alternatives is most promising from a cost-effectiveness perspective. Methods The previously validated Microsimulation Screening Analysis-Colon model was used to evaluate the cost-effectiveness of screening with capsule endoscopy every 5 or 10 years, computed tomographic colonography every 5 years, the multi-target stool DNA test every 1 or 3 years, and the methylated SEPT9 DNA plasma assay (mSEPT9) every 1 or 2 years. We also compared these strategies with annual FIT screening and colonoscopy screening every 10 years. Quality-adjusted life-years gained (QALYG), number of colonoscopies, and incremental cost-effectiveness ratios were projected. We assumed a willingness-to-pay threshold of $100 000 per QALYG. Results Among the alternative tests, computed tomographic colonography every 5 years, annual mSEPT9, and annual multi-target stool DNA screening had incremental cost-effectiveness ratios of $1092, $63 253, and $214 974 per QALYG, respectively. Other screening strategies were more costly and less effective than (a combination of) these 3. Under the assumption of perfect adherence, annual mSEPT9 screening resulted in more QALYG, CRC cases averted, and CRC deaths averted than annual FIT screening but led to a high rate of colonoscopy referral (51% after 3 years, 69% after 5 years). The alternative tests were not cost-effective compared with FIT and colonoscopy. Conclusions This study suggests that for individuals not willing to participate in FIT or colonoscopy screening, mSEPT9 is the test of choice if the high colonoscopy referral rate is acceptable to them.

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Error in Byline in: Computed Tomographic Colonography to Screen for Colorectal Cancer, Extracolonic Cancer, and Aortic Aneurysm: Model Simulation With Cost-effectiveness Analysis

Archives of Internal Medicine ◽

10.1001/archinte.168.12.1269 ◽

2008 ◽

Vol 168 (12) ◽

pp. 1269

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Aortic Aneurysm ◽

Model Simulation ◽

Cost Effectiveness Analysis ◽

Computed Tomographic Colonography ◽

Computed Tomographic ◽

Extracolonic Cancer ◽

Effectiveness Analysis ◽

Aneurysm Model

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Colon Capsule Endoscopy vs. CT Colonography Following Incomplete Colonoscopy: A Systematic Review with Meta-Analysis

Cancers ◽

10.3390/cancers12113367 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3367

Author(s):

Ulrik Deding ◽

Lasse Kaalby ◽

Henrik Bøggild ◽

Eva Plantener ◽

Mie Kruse Wollesen ◽

...

Keyword(s):

Capsule Endoscopy ◽

Diagnostic Yield ◽

Meta Analysis ◽

Rate Sensitivity ◽

Completion Rate ◽

Polyp Detection ◽

Proximal Point ◽

Incomplete Colonoscopy ◽

Colon Capsule Endoscopy ◽

Colon Capsule

Following incomplete colonoscopy (IC) patients often undergo computed tomography colonography (CTC), but colon capsule endoscopy (CCE) may be an alternative. We compared the completion rate, sensitivity and diagnostic yield for polyp detection from CCE and CTC following IC. A systematic literature search resulted in twenty-six studies. Extracted data included inter alia, complete/incomplete investigations and polyp findings. Pooled estimates of completion rates of CCE and CTC and complete colonic view rates (CCE reaching the most proximal point of IC) of CCE were calculated. Per patient diagnostic yields of CCE and CTC were calculated stratified by polyp sizes. CCE completion rate and complete colonic view rate were 76% (CI 95% 68–84%) and 90% (CI 95% 83–95%). CTC completion rate was 98% (CI 95% 96–100%). Diagnostic yields of CTC and CCE were 10% (CI 95% 7–15%) and 37% (CI 95% 30–43%) for any size, 13% (CI 95% 9–18%) and 21% (CI 95% 12–32%) for >5-mm and 4% (CI 95% 2–7%) and 9% (CI 95% 3–17%) for >9-mm polyps. No study performed a reference standard follow-up after CCE/CTC in individuals without findings, rendering sensitivity calculations unfeasible. The increased diagnostic yield of CCE could outweigh its slightly lower complete colonic view rate compared to the superior CTC completion rate. Hence, CCE following IC appears feasible for an introduction to clinical practice. Therefore, randomized studies investigating CCE and/or CTC following incomplete colonoscopy with a golden standard reference for the entire population enabling estimates for sensitivity and specificity are needed.

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